Introduction to Recovery

You have finally owned up to the fact that you have a mental illness. Now what?

In many respects, the worst is behind you. You are out of denial. You have acknowledged reality. You have identified the problem. You are being treated. Things can only get better, right?

Ummm … You’re no longer bouncing off of walls and ceilings or thinking of throwing yourself off a bridge, but you’re probably in no shape to go back to work or resume relationships. You are struggling inside yourself. Each day poses special challenges. You are alone and isolated.

On top of that, you are likely to be dealing with the fall-out of your most recent episode. If you’re lucky, maybe you only caused a scene and can make amends. But too many of us have to contend with a lot worse.

Plus there is emotional trauma to deal with, an illness episode that turned your world upside down and perhaps left you for dead. The shell-shock can be severe.

Maybe your situation is a bit different. Maybe you have been seeing a psychiatrist for years. Maybe you also see a talking therapist. You are better than you were before, but you are not well. In many ways - especially if you are putting up with meds side effects - you may be feeling a lot worse. Is this it? you may wonder. Am I doomed to live the rest of my life - like this?

Maybe you’re one of the lucky ones. The meds work like a charm. The talking therapy is just what the doctor ordered. You quickly return to your old life. But a nagging thought persists: What if my illness returns? Will I be able to survive it? Will I be able to hold onto my job? Will I stay solvent? Will my friends and loved ones stand by me?

Regardless of where you stand, it all comes down to these two simple questions: Will I get well and stay well? What do I need to be doing?

The Treatment-Recovery Continuum

Recovery is a non-starter without medical treatment. Conversely, medical treatment works much better if both you and your clinician are thinking in terms of recovery.

During your initial phases of treatment, you are likely to be a passive recipient of care. You’re not thinking entirely rationally, after all. You know next to nothing about your illness, much less how to manage it, much less your treatment options. Your clinician needs to be calling the shots. The meds will be doing the heavy lifting.

But that will change once your brain starts to come back on line, as you acquire new insights into your illness, and you implement new coping skills. Doctors are notoriously authoritarian by nature, but ironically - probably without them being aware of it - they are very quick to abdicate their authority back over to you. Meds will make us better, after all, but they will not necessarily make us well.

Psychiatry is very good at getting us to “better.” The success rates for “better” are very high, backed by impressive research. “Well” is far more problematic. Virtually no research exists. There is no evidence base, no way of determining how successful psychiatry is in this regard, if at all.

We do know there is strong evidence to support staying on one’s meds over the long term, that going off meds is a sure-fire invitation to relapse or recurrence. But relapse from what? A state of “better?”

Thus, in the treatment-recovery continuum, the clinical relationship gradually shifts to you assuming the lead role. Your psychiatrist has gotten you to better, but the emphasis has changed to things you can do to get well and stay well.

What to Expect

In managing our recovery, we don’t sit around waiting for things to happen. Yet, we accept the fact that healing takes time.

We are constant works-in-progress. In this recovery series, I focus on a number of practical strategies we can use to improve our lives right now. But the real benefits generally take years to accrue. Moreover, there is a good news-bad news aspect of recovery:

The good news is that actively managing your illness works. The bad news is you have to do it. We know, for instance, that exercise is as good for depression as an antidepressant. But who wants to exercise, especially if you’re depressed?

On one hand, I will be preaching personal responsibility. On the other hand, I know what we are up against. Even so-called normal people find it difficult to kick bad habits and implement new ones. Personal change is difficult to achieve in the best of situations.

But the stakes are much higher for us. So-called normal people are likely not have to pay the consequences for their bad habits until much later in life. Our illness tends to hit us when we’re young, in the prime of life. The consequences of our actions are often immediate. Just losing a night’s sleep, for instance, can bring on a next-day mania. Failure to make a major course correction in a stressful situation can be an instant relationship-wrecker and career-wrecker.

The list goes on and on.

On one hand, we are vulnerable - change is an uphill struggle. On the other, we are vulnerable - we have to change.

We are all experts in falling down seven times and getting up eight, so please give yourself credit for the kind of strength and courage the rest of the world refuses to acknowledge you have. If there is one piece of advice I can offer above everything else, it is this:

Never give up on yourself. You may or may not be able to get your old life back, but you are entitled to one as productive and rewarding, if not more so, than your old one.

In the meantime, it pays to keep your goals modest and your expectations low. Baby steps. Lots of patience. Lots of forgiveness. Progress is never linear. You may face crushing defeats, but never regard yourself as defeated.

My qualifications are as follows: I am an expert in failure. I am an expert in wrecking my life. I know where you are coming from. I know what you are up against. We’re in this together. Together, we learn from each other.

Let’s get started …

John is an author and advocate for Mental Health. He wrote for HealthCentral as a patient expert for Depression and Bipolar Disorder.